HP RN Quality of Care
Core
Investigate referred quality of care concerns for health plan members by reviewing medical records, ensuring compliance, and coordinating care to maintain safety and quality standards.
Role type
Senior Registered Nurse (Quality Management)
Builds
Quality of care case investigations and compliance reports for Banner University Health Plan members
Domain
Healthcare / Insurance Quality Management
Required skills
Medical record review, regulatory knowledge (Medicare/AHCCCS), data analysis, risk identification, independent decision making, communication
Preferred skills
Quality management experience, CPHQ certification
Technologies
AHCCCS portal, case management databases
Responsibilities
Review medical records for quality of care cases, triage new referrals, collaborate with providers and internal teams, present cases to Medical Director, identify risk management and compliance issues, conduct onsite health and safety visits in the Phoenix metro area
Seniority
Mid-level, hands-on IC